Lavery et al used venous lactate concentrations to triage trauma patients. This can help reduce the tendency to over-triage patients to tertiary trauma centers. The authors are from UMDNJ Medical School and the New Jersey Trauma Center.
The advantage of the venous lactate measurement is that it does not require an arterial sample.
estimated arterial lactate concentration in mmol/L =
= (0.889 * (venous lactate concentration in mmol/L)) + 0.076
A venous lactate concentration >= 2.0 mmol/L:
(1) correlates with an ISS >= 13
(2) the need for ICU care
(3) increased mortality
Venous Lactate |
Mortality Rate |
0 mmol/L |
4% |
2.5 mmol/L |
6% |
5.0 mmol/L |
12% |
7.5 mmol/L |
21% |
10.0 mmol/L |
38% |
12.5 mmol/L |
55% |
15.0 mmol/L |
71% |
17.5 mmol/L |
84% |
from Figure 4, page 662
If this data is analyzed in JMP:
percent mortality =
= (-0.018909 * ((venous lactate)^3)) + (0.6839827 * ((venous lactate)^2)) - (1.62381 * (venous lactate)) + 4.72727
Performance:
• Triage worked best for patients with blunt trauma in motor vehicle accidents.
Limitations:
• A small injury may not be associated with a significant rise in lactate early, resulting in a false negative result.
• The specimen needs to be collected, transported and tested properly to give valid results.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,